Devi D S Karthika, Mary J Jenifer Florence, Mohan Reenaa, Gavlasova Dominika, Kalaiselvan G, Kathiravan E, Foppiani Jose A, Saravanan V, Devi M Archana, Lin Samuel J
Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India.
Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute, SBV (Deemed to be University), Puducherry, India.
Indian J Nephrol. 2024 Sep-Oct;34(5):431-441. doi: 10.25259/ijn_365_23. Epub 2024 Jul 8.
Hypertension is an important factor driving mortality among dialysis patients. Angiotensin-II receptor blocker (ARB) has been effective similarly to angiotensin-converting enzymes (ACEs) but with a low incidence of side effects.
The meta-analysis included all published studies that investigated the effect of ARB on the hypertension in adult dialysis patients (≥18 years). Data extraction was guided by a predetermined checklist. Data sources of the retrieved studies were PubMed, MEDLINE, ScienceDirect, SCOPUS, Cochrane, Web of knowledge, and Google Scholar were systematically searched until February 2023. Using the RevMan 5 software, the mean difference for systolic and diastolic BP (SBP and DBP) and the risk ratio (RR) of the adverse events (AEs) were pooled from the selected studies. The random-effects model was used to compare the difference in the pre-and post-dialysis of the SBP and DBP. Data analyses were performed from December 2022 to February 2023. The primary outcome was the reduction in SBP and DBP in dialysis hypertensive patients who were on anti-hypertensive agents, and the secondary outcome was assessment of AE associated with the drug after dialysis (PROSPERO Registration: CRD42022355369).
The initial search yielded 1,679 records, of which 84 studies underwent full-text evaluation, which identified 13 studies and 1,462 patients. The pooled standard MD for losartan with other anti-hypertensive agents, where the pre-dialysis SBP was 0.17 (95% confidence interval [CI]: -0.21-0.55) and the post-dialysis was 0.35 (95% CI: -0.17-1.02); yet, both are statistically non-significant, implies that there was no difference between Losartan and ARB drugs regarding the effect on the SBP. Diastolic BP for predialysis was -0.01 (95% CI: -0.65-0.63) and post-dialysis was 0.03 (95% CI: -0.24-0.30) and statistically non-significant. AEs by the ARB agents were lower compared to other anti-antihypertensive agents (relative risk [RR]: 1.01; 95% CI: 0.59-1.75) and statistically non-significant.
This systematic review and meta-analysis of RCT demonstrated that ARB and other anti-hypertensive medications had similar impacts on the treatment of hypertension.
高血压是导致透析患者死亡的一个重要因素。血管紧张素II受体阻滞剂（ARB）的效果与血管紧张素转换酶抑制剂（ACE）相似，但副作用发生率较低。
本荟萃分析纳入了所有已发表的研究，这些研究调查了ARB对成年透析患者（≥18岁）高血压的影响。数据提取以预先确定的清单为指导。检索到的研究的数据来源包括PubMed、MEDLINE、ScienceDirect、SCOPUS、Cochrane、Web of knowledge和Google Scholar，系统检索至2023年2月。使用RevMan 5软件，从选定的研究中汇总收缩压和舒张压（SBP和DBP）的平均差值以及不良事件（AE）的风险比（RR）。采用随机效应模型比较透析前后SBP和DBP的差异。数据分析于2022年12月至2023年2月进行。主要结局是接受抗高血压药物治疗的透析高血压患者SBP和DBP的降低，次要结局是评估透析后与药物相关的AE（PROSPERO注册号：CRD42022355369）。
初步检索得到1679条记录，其中84项研究进行了全文评估，确定了13项研究和1462名患者。氯沙坦与其他抗高血压药物的合并标准MD，透析前SBP为0.17（95%置信区间[CI]：-0.21-0.55），透析后为0.35（95%CI：-0.17-1.02）；然而，两者在统计学上均无显著性差异，这意味着氯沙坦和ARB药物在对SBP的影响方面没有差异。透析前舒张压为-0.01（95%CI：-0.65-0.63），透析后为0.03（95%CI：-0.24-0.30），在统计学上无显著性差异。与其他抗高血压药物相比，ARB药物引起的AE较低（相对风险[RR]：1.01；95%CI：0.59-1.75），且在统计学上无显著性差异。
这项对随机对照试验的系统评价和荟萃分析表明，ARB和其他抗高血压药物在高血压治疗方面具有相似的影响。
